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Journal Articles Radiology Year : 2020

Brain MRI Findings in Severe COVID-19: A Retrospective Observational Study

Stéphane Kremer (1, 2) , François Lersy (1) , Jérome de Sèze (1) , Jean-Christophe Ferré (3) , Adel Maamar (4) , Béatrice Carsin-Nicol (3) , Olivier Collange (1) , Fabrice Bonneville (5) , Gilles Adam (5) , Guillaume Martin-Blondel (6) , Marie Rafiq (7) , Thomas Geeraerts (8) , Louis Delamarre (8) , Sylvie Grand (9) , Alexandre Krainik (9) , Manel Alleg (10) , Mathieu Anheim (11) , René Anxionnat (12) , François-Daniel Ardellier (1) , Seyyid Baloglu (1) , Blanche Bapst (13) , Joseph Benzakoun (14) , Jérome Berge (15) , Federico Bolognini (16) , Grégoire Bornet (17) , Clotilde Boulay (1) , Grégoire Boulouis (14) , Claire Boutet (18) , Jean Christophe Brisset (19) , Sophie Caillard (1, 20) , Sophie Carré (10) , Pierre-Olivier Comby (21) , Jean Marc Constans (22) , Jean-Stéphane David (23) , Isaure de Beaurepaire (17) , Hubert Desal (24) , Myriam Edjlali-Goujon (14) , Xavier Fabre (25) , Samira Fafi-Kremer (1) , Philippe Feuerstein (26) , Marie-Cécile Henry Feugeas (27) , Géraud Forestier (28) , Augustin Gaudemer (27) , Yves Hansmann (29) , Adrien Heintz (22) , Julie Helms (30, 31) , Céline Hemmert (26) , Ghazi Hmeydia (14) , Lavinia Jager (32) , Apolline Kazémi (33) , Basile Kerleroux (14) , Antoine Khalil (27) , Audrey Lacalm (23) , Augustin Lecler (34) , Claire Lecocq (10) , Nicolas Lefèbvre (29) , Muriel Matthieu (1) , Imen Dr Megdiche (13) , Paul-Michel Mertes (1) , Julien Messié (16) , Serge Metanbou (22) , Nicolas Meyer (29) , Ferhat Meziani (35) , Véronique Mutschler (1) , Patrick Nesser (32) , Hélène Oesterlé (16) , Mickael Ohana (30) , Catherine Oppenheim (14) , Nadya Pyatigorskaya (36) , Frédéric Ricolfi (21) , Suzana Saleme (28) , Maleka Schenck (1) , Emmanuelle Schmitt (12) , Francis Schneider (1) , Nathan Sebag (26) , Yannick Talla Mba (32) , Pierre Thouant (21) , Thibault Willaume (1) , François Zhu (12) , Pierre-Emmanuel Zorn (1) , François Cotton (37)
1 HUS - Les Hôpitaux Universitaires de Strasbourg
2 ICube - Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie
3 Département de Radiologie [CHU de Rennes]
4 Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes]
5 Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
6 Service Maladies infectieuses et tropicales [CHU Toulouse]
7 Département Neurologie [CHU Toulouse]
8 Pôle Anesthésie Réanimation [CHU de Toulouse]
9 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
10 Centre hospitalier de Haguenau
11 IGBMC - Institut de Génétique et de Biologie Moléculaire et Cellulaire
12 CHU Nancy - Centre Hospitalier Universitaire de Nancy
13 CHU Henri Mondor [Créteil]
14 IPNP - U1266 Inserm - Institut de psychiatrie et neurosciences de Paris
15 CHU Bordeaux
16 Hôpitaux Civils de Colmar
17 Hôpital Privé d'Antony
18 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
19 OFSEP - Observatoire Français de la Sclérose En Plaques [Lyon]
20 IRM - Immuno-Rhumatologie Moléculaire
21 CHU Dijon
22 CHU Amiens-Picardie
23 HCL - Hospices Civils de Lyon
24 CHU Nantes - Centre Hospitalier Universitaire de Nantes
25 CH Roanne - Centre Hospitalier de Roanne
26 GHRMSA - Groupe hospitalier de la région de Mulhouse Sud-Alsace
27 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
28 CHU Limoges
29 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
30 Nouvel Hôpital Civil de Strasbourg
31 UNISTRA - Université de Strasbourg
32 Hôpital Marie-Madeleine [Forbach]
33 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
34 Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
35 NanoRegMed - Nanomédecine Régénérative
36 ICM - Institut du Cerveau = Paris Brain Institute
37 CREATIS - Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé
Marie Rafiq
Manel Alleg
René Anxionnat
Jérome Berge
Federico Bolognini
Grégoire Bornet
Pierre-Olivier Comby
Jean Marc Constans
Jean-Stéphane David
Hubert Desal
Xavier Fabre
Géraud Forestier
Lavinia Jager
Audrey Lacalm
Claire Lecocq
Julien Messié
Hélène Oesterlé
Mickael Ohana
Frédéric Ricolfi
Suzana Saleme
Yannick Talla Mba
Pierre Thouant

Abstract

Background Brain MRI parenchymal signal abnormalities have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Purpose To describe the neuroimaging findings (excluding ischemic infarcts) in patients with severe coronavirus disease 2019 (COVID-19) infection. Materials and Methods This was a retrospective study of patients evaluated from March 23, 2020, to April 27, 2020, at 16 hospitals. Inclusion criteria were (a) positive nasopharyngeal or lower respiratory tract reverse transcriptase polymerase chain reaction assays, (b) severe COVID-19 infection defined as a requirement for hospitalization and oxygen therapy, (c) neurologic manifestations, and (d) abnormal brain MRI findings. Exclusion criteria were patients with missing or noncontributory data regarding brain MRI or brain MRI showing ischemic infarcts, cerebral venous thrombosis, or chronic lesions unrelated to the current event. Categorical data were compared using the Fisher exact test. Quantitative data were compared using the Student t test or Wilcoxon test. P < .05 represented a significant difference. Results Thirty men (81%) and seven women (19%) met the inclusion criteria, with a mean age of 61 years ± 12 (standard deviation) (age range, 8–78 years). The most common neurologic manifestations were alteration of consciousness (27 of 37, 73%), abnormal wakefulness when sedation was stopped (15 of 37, 41%), confusion (12 of 37, 32%), and agitation (seven of 37, 19%). The most frequent MRI findings were signal abnormalities located in the medial temporal lobe in 16 of 37 patients (43%; 95% confidence interval [CI]: 27%, 59%), nonconfluent multifocal white matter hyperintense lesions seen with fluid-attenuated inversion recovery and diffusion-weighted sequences with variable enhancement, with associated hemorrhagic lesions in 11 of 37 patients (30%; 95% CI: 15%, 45%), and extensive and isolated white matter microhemorrhages in nine of 37 patients (24%; 95% CI: 10%, 38%). A majority of patients (20 of 37, 54%) had intracerebral hemorrhagic lesions with a more severe clinical presentation and a higher admission rate in intensive care units (20 of 20 patients [100%] vs 12 of 17 patients without hemorrhage [71%], P = .01) and development of the acute respiratory distress syndrome (20 of 20 patients [100%] vs 11 of 17 patients [65%], P = .005). Only one patient had SARS-CoV-2 RNA in the cerebrospinal fluid. Conclusion Patients with severe coronavirus disease 2019 and without ischemic infarcts had a wide range of neurologic manifestations that were associated with abnormal brain MRI scans. Eight distinctive neuroradiologic patterns were described.

Domains

Neuroscience

Dates and versions

inserm-03482261 , version 1 (15-12-2021)

Identifiers

Cite

Stéphane Kremer, François Lersy, Jérome de Sèze, Jean-Christophe Ferré, Adel Maamar, et al.. Brain MRI Findings in Severe COVID-19: A Retrospective Observational Study. Radiology, 2020, 297 (2), pp.E242-E251. ⟨10.1148/radiol.2020202222⟩. ⟨inserm-03482261⟩
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